National survey of provider opinions on controversial characteristics of liver transplant candidates

Katharine Secunda, Elisa J. Gordon, Min W. Sohn, Laura A. Shinkunas, Lauris C. Kaldjian, Michael D. Voigt, Josh Levitsky*

*Corresponding author for this work

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of US transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online, anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5%) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age ≥ 80 years (62.7%), a body mass index ≥ 45 kg/m2 (56.6%), and current incarceration with a lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria. Liver Transpl 19:395-403, 2013. © 2012 AASLD.

Original languageEnglish (US)
Pages (from-to)395-403
Number of pages9
JournalLiver Transplantation
Volume19
Issue number4
DOIs
StatePublished - Apr 1 2013

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Transplants
Liver
Liver Transplantation
Social Justice
Cannabis
Mental Disorders
Ethics
Psychiatry
Surveys and Questionnaires
Body Mass Index
Multivariate Analysis

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Secunda, Katharine ; Gordon, Elisa J. ; Sohn, Min W. ; Shinkunas, Laura A. ; Kaldjian, Lauris C. ; Voigt, Michael D. ; Levitsky, Josh. / National survey of provider opinions on controversial characteristics of liver transplant candidates. In: Liver Transplantation. 2013 ; Vol. 19, No. 4. pp. 395-403.
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abstract = "Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of US transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online, anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5{\%}) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age ≥ 80 years (62.7{\%}), a body mass index ≥ 45 kg/m2 (56.6{\%}), and current incarceration with a lifetime sentence (54.7{\%}) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria. Liver Transpl 19:395-403, 2013. {\circledC} 2012 AASLD.",
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National survey of provider opinions on controversial characteristics of liver transplant candidates. / Secunda, Katharine; Gordon, Elisa J.; Sohn, Min W.; Shinkunas, Laura A.; Kaldjian, Lauris C.; Voigt, Michael D.; Levitsky, Josh.

In: Liver Transplantation, Vol. 19, No. 4, 01.04.2013, p. 395-403.

Research output: Contribution to journalReview article

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AU - Secunda, Katharine

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AU - Sohn, Min W.

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AB - Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of US transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online, anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5%) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age ≥ 80 years (62.7%), a body mass index ≥ 45 kg/m2 (56.6%), and current incarceration with a lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria. Liver Transpl 19:395-403, 2013. © 2012 AASLD.

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